Download NR566 FINAL ADVANCE PHARMACOLOGY QUESTIONS WITH COMPLETE SOLUTIONS and more Exams Nursing in PDF only on Docsity!
NR566 FINAL ADVANCE PHARMACOLOGY
QUESTIONS WITH COMPLETE SOLUTIONS
· Papaverine plus phentolamine Patient Education Correct Answers Do not inject more than once in a 24 hours period, notify provide if erection duration and efficacy, consult MD before taking new medication, seek medical attention right away if erection is >3 hours 1st line treatment for acute, mid to moderate migraine without nausea or vomiting Correct Answers NASID: Naproxen and ASP 1st line treatment for General anxiety Correct Answers both SSRI AND SNRI are considered 1st line treatment GAD. SSRI: Paroxetine(Paxil)Escitalopram (Lexapro) SNRI: Venlafaxine (Effexor XR), duloxetine (Cymbalta), Buspirone 1st line treatment for panic disorder Correct Answers The SSRIs are first-line drugs for PD fluoxetine (Prozac) Paroxetine(Paxil) and sertraline (Zoloft) 1st line treatment for performance anxiety Correct Answers Propranolol (INDERAL )and other B blockers can benefits patients with performance anxiety 1st line treatment for sleep disturbance Correct Answers Benzodiazepine Triazolam Benzodiazepine-Like Drugs Zolpidem ,Zaleplon, and eszopiclone
Barbiturate :Secobarbital Melatonin Receptor Agonist :Ramelteon , melatonin Orexin Receptor Agonist: Suvorexant A patient with what type of condition should not take echinacea? Correct Answers HIV immunocompromised patients tuberculosis AUTOIMMUNE DISORDER Alprostadil benefits of various routes: for ED Correct Answers The injection needs to be done by the patient or in ER setting: rapidly leads to erection, painless Intraurethral pellet insertion: can be done by the patient, an erection occurs within 5-10 mins minimal side effects Androgen therapy appropriate vs. not needed related to puberty Correct Answers Short term: The psychological pressures of delayed sexual maturation are causing a boy significant distress Long term: if delayed puberty related to true hypogonadism Bacterial Vagionosis 1st line Treatment Correct Answers Non pregnant metronidazole 500 mg 2xdays for 7 days pregnant - vaginal metronidazole 2% for 7 days clindamycin 1% for 7 days baseline data needed to prescribe Serotonin/Norepinephrine Reuptake Inhibitors (SNRI) Correct Answers Serum sodium should be checked in older adults and patients on diuretic therapy.
supplements (e.g., Boost) and snacks between meals. Schedule an appointment with a registered dietician. Depression medication black box weaning Correct Answers Patients with depression often think about or attempt suicide. During treatment with antidepressants, especially early on, the risk for suicide may actually increase. Concerns about antidepressant-induced suicide apply mainly to children, adolescents, and adults younger than 25 years. Depression treatment first drug doesn't seem to be working: Correct Answers Increase the dosage.
- Switch to another drug in the same class.
- Switch to another drug in a different class
- Add a second drug, such as an atypical antidepressant. it should be used for 4 to 8 weeks to assess efficacy. Depression treatment options, Correct Answers The usual drugs of first choice are the SSRIs, SNRIs, bupropion, and mirtazapine Dietary restriction pt taking MAOI Correct Answers Food containing tyramine Donepezil (Aricept) when would it be appropriate to increase the dose? Correct Answers patient are stabilized on the initial dosage for 1 to 3 months before an increased in dosage
doxazosin (BPH treatment) (a1 blocker) side effect Correct Answers side effect hypotension, dizziness, nasal congestions Dutasteride (Avodart) BPH treatment (5a reductase inhibitors) patient teaching Correct Answers benefits take months to develop, must continue taking med even if improvement not readily seen may lower ejaculatory volume and libido Examples of opioid analgesics reserved for severe migraines that don't respond to first-line medications Correct Answers Butorphanol nasal spray use one spray each nostril every 60 minutes PRN First generation antipsychotics (FGA) Correct Answers All of the FGAs produce a strong blockade of dopamine in the central nervous system (CNS). As a result, they all can cause serious movement disorders, known as extrapyramidal symptoms (EPSs) and tardive dyskinesia(TD) Ginger Root Adverse Effects Correct Answers have the potential to cause CNS depression and cardiac dysrhythmias. Excessive doses may also cause GI disturbances Ginkgo Biloba adverse effects Correct Answers Mild GI Upset Headache Lightheadedness Side Effects reduced by reducing dose
HSV (herpes simplex virus) 12st line treatment Correct Answers 1 Clinical episode: Acyclovir 400 mg 3x days for 7- days 2 Clinical episode: Acyclovir 800 mg 2x days for 5 days Kava adverse effects Correct Answers sever live injury , hepatotoxicity Laws related to CAM, Current Good Manufacturing Practices (CGMP) ruling of 2007 Correct Answers regulates supplement manufacturing and labeling to ensure supplements are free of contaminants and prevent mislabeling These standards, referred to as CGMP, are designed to ensure that dietary supplements be devoid of adulterants, contaminants, and impurities and that package labels accurately reflect the identity, purity, quality, and strength of what is inside. Laws related to CAM, Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006 Correct Answers mandates reporting of serious adverse effects of nonprescription drugs and dietary supplements. Laws related to CAM, Dietary Supplement Health and Education Act (DSHEA) of 1994 Correct Answers classifies dietary supplements as food supplements, not drugs and exempts supplements from FDA approval process. The Food, Drug, and Cosmetic Act requires that conventional drugs—both prescription and over-the-counter agents—undergo
rigorous evaluation of safety and efficacy before receiving FDA approval for marketing. Lithium drug interactions Correct Answers Diuretics, NSAIDs, and anticholinergics Lithium therapeutic range Correct Answers Lithium levels should remain between 0.4 and 1 mEq/L. Generally levels should be between 0.6 and 0.8 mEq/L. Levels of 0.8 to 1 mEq/L may be more effective but carry a greater risk of adverse effects. Medroxyprogesterone Acetate benefits Correct Answers doesn't cause thromboembolic disorder, headache, nausea or most of the other adverse effects associated with combo OCs. melatonin receptor agonist Correct Answers Ramelteon (Rozerem), melatonin Patient education about administration/consumption flaxseed Correct Answers Flaxseed may reduce the absorption of conventional medications. Therefore it should be taken 1 hour before or 2 hours after these drugs. Patient experience sleep attacks associated with PD treatment? Correct Answers pt experience overwhelming/irresistible sleepiness that comes on without earning Patient taking memantine what to do when pt has an elevated creatinine clearance Correct Answers Dosage adjustment is
Pramipexole (Mirapex) adverse effect Correct Answers Nausea, dizziness, daytime sleep attacks, insomnia, constipation, weakness, and hallucinations, impulse control disorder can occur ( excessive gambling, spending etc) Preventive therapy for migraines headache Correct Answers Metoprolol/propranolol ( Beta-blockers ) are often used as preventive therapy Progesterone (progestin) When is day not safe to prescribe Correct Answers if women has had a hysterectomy/pregnant Rivastigmine (Exelon) patient teaching Correct Answers can cause bradycardia, fainting, fall, and fall-related fractures. family teaching how to prevent fall at home Side effect of progestin oral contraceptives Correct Answers it can cause irregular/ inconsistent bleeding, must be take at same time very day to be effective Side effect of testosterone replacement therapy Correct Answers hot flashes, bone fx, decrease libido, insulin resistance, erectile dysfunction, acne, HTN, sterility, aggression, and mood swings. SSRI common adverse effects Correct Answers Sexual dysfunction Weight gain Serotonin syndrome
SSRIs baseline data needed to prescribe common adverse effects Correct Answers Serum sodium should be checked in older adults and patients on diuretic therapy SSRIs drug interactions Correct Answers •MAOIs-serotonin syndrome Antiplatelet drugs and anticoagulants St. John's Wort adverse effects Correct Answers Allergic skin reactions may occur, especially in people allergic to ragweed and daisies. In addition, the herb may cause CNS effects (e.g., insomnia, vivid dreams, restlessness, anxiety, agitation, and irritability), as well as GI discomfort, fatigue, dry mouth, and headache. High-dose therapy may pose a risk for phototoxicity Strategies to minimize adverse effects of SNRI Correct Answers Educate patients that abrupt cessation of these drugs is not recommended. Patients should also report thoughts of suicide or self-harm immediately Strategies to minimize adverse effects of SSRI Correct Answers Educate patients that abrupt cessation of these drugs is not recommended. Patients should also report thoughts of suicide or self-harm immediately Symptom of serotonin syndrome withdrawal Correct Answers dizziness, headache, nausea, sensory disturbances, tremor, anxiety, and dysphoria
Therapeutic effect Coenzyme Q-10 Correct Answers • Patients with heart failure who took CoQ-10 had improved cardiac function.
- Patients who took CoQ-10 after cardiac surgery had faster recovery.
- CoQ-10 may improve sperm count and semen quality; however, further studies are needed to identify an improvement in conception. Therapeutic effect Feverfew Correct Answers Feverfew is used primarily for the prophylaxis of migraine. The AAN recommends dosing at 50 to 300 mg twice daily for migraine prophylaxis Trichomoniasis treatment Correct Answers Metronidazole (Flagyl) 500 mg 2x day for 7 days (WOMEN) single dose of 2 grams for MEN MEN or Women tinidazole 2g single Triptans contraindications Correct Answers History of ischemic heart disease, uncontrolled hypertension, cerebrovascular disease, pregnancy, basilar or hemiplegic migraine; use within 24 hours of an ergot derivative Uncomplicated gonorrhea urethritis treatment Correct Answers ceftriaxone 500 mg IM single dose with or without doxycycline 100 mg 2x days for days Use of levodopa/carbidopa in treatment/diagnosis Correct Answers Dopamine replacement, first-line drug/treatment to dopamine agent) maintain or improve pts ADLs
Adverse effects: orthostatic hypotension, psychosis, dyskinesia what education needed Patients taking MAOI medication Correct Answers Patients should be informed about the symptoms of hypertensive crisis (headache, tachycardia, palpitations, nausea, vomiting, sweating) and instructed to seek immediate medical attention if these develop what education needed Patients taking TCA medication Correct Answers Patients should be informed that they can minimize orthostatic hypotension by moving slowly when assuming an upright posture. In addition, patients should be instructed to sit or lie down if symptoms (dizziness, lightheadedness) occur. What foods contain tyramine? Correct Answers - Avocados, aged meats, bean curd, bananas, cold cuts/sausages, cured fish, cheese, yeast, beers, protein supplements, soups, shrimp, soy sauce, chocolate, caffeine What is abortive therapy for migraines headache and when is it used? Correct Answers Abortive medications stop a migraine when pt feels one coming or once it has begun. NSAIDS and opioid and migraine-specific meds ( Triptans and Ergot alkaloids) used at 1st sign of attack What seizure medication reduces OC efficacy? Correct Answers Carbamazepine, eslicarbazephine, lamotrigine, oxcarbazepine, phenytoin, phenobarbital, rufinamide, topiramate
